2016 Registration Form

2016RegistrationForm
PleaseCircleone
Football Cheer
Pleaseprintandcompleteallfieldsandsignbelow
FirstName:_________________________________LastName:__________________________________M.I._______
Age(asofOctober1,2016):_____________________DateofBirth:____________________________________
Address:_______________________________________________________________________________________________
City:___________________________________State:_______________________Zip:_____________________________
Phone:________________________________________ChildResideswith:_____Both_____Mother_____Father
SchoolAttending(asofSept.2016):________________________________________________Grade:____________
Mother’sName:_______________________________________Father’sName:__________________________________
Mother’sCell:_________________________________________Father’sCell:_____________________________________
LegalGuardian(ifnotmotherorfather):_______________________________________________________________
Pleaseprovideanemailaddresswhereyouwouldlikeinformationsentregarding
Gameschedules,practices,cancellationsetc.
1. ____________________________________________________________________________________
2.______________________________________________________________________________________
REFUNDPOLICY
TheWYFAwillrefundregistrationfeeONLYif:
1.Athleteisnotmedicallyclearedtoplay.
2.AthletesustainsaseasonendinginjuryonorbeforeSeptember1,2016.
Refund Request must be submitted in writing to the Commissioner along with supporting
documentation.
All monies collected by the WYFA through fundraising or incentives are NON-REFUNDABLE.
Incentive prizes earned will be given only to members in good standing. The Head Coach will
determinewhichAthletesareingoodstanding.Allmoniescollected,includingdepositsforPost
SeasonTravelareNON-REFUNDABLE.
THEWYFAWILLNOTISSUEANYREFUNDFORANYREASON,AFTERSEPTEMBER1,2016
Parent/GuardianSignature________________________________Date_______________________
2016ConsentandReleaseForm
AthleteName:_____________________________________
I,_________________________theparent/guardianoftheabovenamedchildherebyagreeasfollows:
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Mychildisphysicallyhealthyandabletoparticipateintheeventsasafootballplayer/cheerleader.
My child, if injured or ill earlier in the year, is now physically fit to participate in such activities according to
his/herphysician.
Mychild’scoacheswillbemadeawareofanycondition,suchasasthma,thataffectmychildandshallbe
allowedtocarrythenecessarymedicationordevices(Epi-pen/inhaler)asmaybenecessary.
At all times, at the site of the events, in case of a medical emergency I hereby authorize any local hospital,
doctor or other licensed medical practitioner, as well as emergency medical treatment personnel (EMT), to
take what they feel are the correct procedures as an aid to my child’s heath and well being. This
permission is extended,asnecessary,tothe“WolverineYouthFootballAssociation,Inc.”andanylocalhosting
organizationof an event, or their employees, agents and volunteers.If I am present and available at the site
and time of the medical emergency, I will retain my right to make all necessary decisions concerning
medical treatment of my child.
Whenattendinganevent,IunderstandmychildisexpectedtostaywiththeTEAMandnotwithmeforthe
duration oftheeventandthatIamresponsibleforprovidingorarrangingtransportationtoandfromsaid
event.
Any travel, hotel, banquet or other arrangements are not the responsibility of the “Wolverine Youth
Football Association,Inc.
If my child is to participate in an event sponsored by the “Wolverine Youth Football Association, Inc.” it is
understoodhe/shewillmaintainsoundscholasticstanding.Allmoniesduetotheorganizationmustbepaidin
fullinorderformychildtoparticipateintheseeventsorreceiveincentiveprizes/trophiesrelatedtothese
events.
If mychildisinjuredataneventandhasseenorbeenreferredtoadoctor,he/shewillobtainawritten
release fromthephysicianpriortoreinstatement.
Itisunderstoodthatthecoach’sstandardwillbemaintainedatalltimes.
Asaparent/guardianIagreetobeanactiveparticipantintheorganizationandacceptresponsibilityformy
“homegame”assignment.IwilldisplaypositivesportsmanshipatalltimesandACCEPTTHEDECISIONSOF
THECOACHINGSTAFF,KNOWINGTHATMYCHILD’SSKILLLEVELANDSAFETYAREOFTHEUTMOST
IMPORTANCE.
Asanathlete,Iagreetomakeacommitmenttomyteambyattendingpractices,games,competitions,
fundraisingactivitiesandfamilyeventssponsoredbytheorganization.Iwillberespectfulofmyparents,
coaches,teammatesandopponents.Iwillbepreparedforeachpractice/gamebyhavingalluniformitems
eitherinmybagoronmybody.Iwilldisplaypositivesportsmanshipatalltimesandacceptthedecisionsofmy
coaches.
Whenparticipatinginaneventmychildmaybephotographedorfilmedandtheorganizationhastheperpetual
righttousecopies,dubsoranyotherreproductionofanyrecordedelement,includingsound,andthenameof
theperson,theirlikeness,orpictureinorinconnectionswiththeexhibitionasmayseenproper.Ialsoagree
thattheabovementioned,minorwillnotdisaffirmordisavowsaidconsentforanyreasonwhatsoeveror
endeavortorecoveranysumsforparticipatingintheabovementionedproduction.
Iunderstandthatmychildwillberequiredtoparticipateinthedesignated“MandatoryFundraiser(s).Ifmy
childdoesnotparticipateinthismandatoryfundraisingevent(s),IunderstandthatIwillbefinancially
responsibleformychild’sexpectedcontribution.Theamountforthe2016seasonwillbe$50.00.
ALLParent/GuardianSignature____________________________________________________Date_____________________________
AAthleteSignature________________________________________________________________Date____________________________
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2016MedicalAuthorizationForm
AthleteName:________________________________________
Intheeventthattheneedarisestoprovideunforeseenoremergencymedical
treatmenttomy son/daughter,Iunderstandthateveryeffortwillbemadeto
contactmeformypermission.However,intheeventthatIcannotbecontacted,I
herebyauthorizethecoachingstaffoftheWolverineYouthFootballAssociation
toactonmybehalfandgivethemtheMedical AssignmentReleasefor
necessarymedicaltreatment.
Pleaseprovidethenameandnumberoftheperson(s)tobecontactedin
theeventofanemergency:
1._____________________________________________________________________________
2._____________________________________________________________________________
3._____________________________________________________________________________
InsuranceCarrier:__________________________________________________________
Mychildisallergictothefollowingmedicationsand/ornatural
substances:
Mychildiscurrentlytakingthefollowingmedications:
Parent/GuardianSignature_________________________________________Date_______________
2016WaiverandReleaseof
LiabilityForm
AthleteName:_____________________________________
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In consideration of being allowed to borrow/use in any way the Wolverine
Youth Football Association, Inc. equipment for athletic/sports program, related
eventoractivityoutsideoftheregularsponsoredseasonevents, theundersigned
acknowledges,appreciates,andagreesto:
The risk of injury from activities involved in this program is significant,
including the potential for permanent paralysis and death, and while particular
rules,equipmentandpersonaldisciplinemayreduce thisrisk,theriskofserious
injurydoesexistand,
Iknowinglyandfreelyassumeallrisks,bothknownandunknown,evenifarising
from the negligence of the releases or others, and assume full responsibility for
myparticipationand
I willingly agree to comply with the stated and customary terms and
conditions for participation. If however, I observe any unusual significant
hazard during my presence or participation, I will remove myself from
participation and bring such to the attention of the nearest person in charge
immediatelyand,
I, for myself and on behalf of my heirs, assigned personal representatives and
next of kin hereby release and hold harmless the Wolverine Youth Football
Association, Inc. their officers, officials, agents and/or coaches with respect to
any and all injury, disability, death or loss or damage to person or property,
whetherarisingfromthenegligenceofthereleasesorotherwise.
Ihavereadthereleaseofliabilityandassumptionofriskagreement,fully
understanditsterms,understandthatIhavegivenupsubstantialrightsbysigningit
andsignitfreelyandvoluntarilywithoutanyinducement.
Parent/GuardianSignature___________________________________Date_________________
THISFORMNEEDSTOBECOMPLETEDBYAMEDICALPROFESSIONAL
ONLYIFPHYSICALISSCHEDULEDAFTERAUGUST1,2016
NameofParticipant
_______________________________________________________
(Pleasecheckthefollowingifhealthyornoteotherwise)
Height
Weight
Eyes
Ears
Mouth
Nose&Throat
Respiratory
Cardiovascular
Neurological
Musculoskeletal
Dermatological
BloodPressure
IherebycertifythatIamalicensedstateexaminerandexaminedtheabovenamed
individualon:________________________(Dateoflastphysical)Iunderstandthathe/shewill
beparticipatingintheWolverineYouthFootballAssociationprogram:
Football/Cheerleading(circleone).
IherebyswearandattestthatthisindividualwasphysicallyfitandIfoundnomedical
reasonthatwouldpreventhim/herfromsafelyparticipatinginWolverineactivitiesfor
the2015season.Iamthereforeclearingthisindividualforathleticparticipation
withoutlimitation.
Theabovenamedparticipanthasanannualphysicalscheduledon:_____________________
Pleaseplacemedicalprofessionalstamphereorfilloutthefollowing:
Signed___________________________________________Today'sDate___________________________
PrintName________________________________________________________________________________
Address____________________________________________________________________________________
Telephone__________________________________________Fax__________________________________
Thisformmustbecompletedinitsentiretybyalicensedstate
examiner(MedicalDoctor,NursePractitioner,etc.)Thismayvary
bystate.Mustbedated2016.
2016ParentVolunteerSignUpForm
AthleteName:______________________________________
TheWolverineorganizationcannotrunwithoutthehelpofparentvolunteers.
Parentvolunteerscontribute greatlytothesuccessoftheprogram.
Weaskeveryparenttobecomeinvolvedinhelpingusmakeyour son’s/daughter’s
experiencewiththeWolverinesonetheywillneverforget.
Pleasesignupforatleastoneofthefollowingpositions:
__________FieldSetup/BreakdownChainCrew__________
__________StatsCrewAnnouncer__________
__________Score/TimeKeeperTeamMom(Football/Cheer)__________
__________ConcessionsBingo__________
Parent(s)/Guardian(s)Name:________________________________________________
________________________________________________
Aparentvolunteermeetingwilltakeplaceonthefirstnightofpractice.
2016ParentChecklist
Yourson/daughterwillnotbeallowedtoparticipatein
ANYWolverineActivity
withoutprovidingthe organizationthefollowingitems:
__________RegistrationFeeintheamountof$50perathlete
(On/AfterJune1stRegistrationFeewillincreaseto$125)
__________RegistrationForm
__________ConsentandReleaseForm
__________MedicalAuthorizationForm
__________WaiverandReleaseofLiabilityForm
__________PhysicalExamDatedafterJanuary1,2016orWYFAPhysicalformifphysicalis
scheduledafterAugust1,2016
__________CopyofBirthCertificate(NewAthletesonly)
__________Finalcopyof2015/2016ReportCard(forSAUverification)
__________LeagueInsuranceWaiver
__________ParentVolunteerSignupSheet
__________EquipmentDeposit(TobecollectedatEquipmenthandoutinJuly)
Pleasemailanymissingpaperworkassoonaspossibleto:
WolverineYouthFootballAssociation
55CrystalAvenue,PMB287
Derry,NH03038
Formoreinformationabouttheorganization,includingourBingoprogram
andtoregisterforemailupdates,pleasevisitourwebsite:
www.derrywolverine.com